The word ‘isolation’ can also be described as ‘the condition of being alone’, so it is no surprise that many of us are struggling with being lonely, low mood and depression. This is especially worrying for those who are over 70. In the younger generation, the term ‘self-isolate’ means staying at home with family, for those who are older, they may already live on their own, and their only human connection is when they go out and visit friends.

If you have an elderly loved one, or neighbor who is self-isolating, check up on them as often as you can, it need only be a short phone call, but you may be the only person they have spoken to that day. If you are the person who is struggling with the loneliness whilst having to self-isolate, there are many help lines who can offer support and a friendly voice when in times of need, such as The Silver Line, who offer a confidential, free helpline or telephone friendship for the elderly; call them on 0800 470 80 90.

Encourage your loved one or neighbor to limit their intake of the news. The more you hear, the more you buy into the panic. This only adds to the current anxiety. Instead, encourage them to watch a lighthearted TV programme or film. You can even watch it alongside them whilst chatting on the phone so it gives them the feeling of company.

Encourage them to stay in touch with the outside world via Skype, WhatsApp or other messaging apps. Many of the elderly now have smartphones and will be aware of these forms of contact, even though it might not be their instinct to use them.

I hope some of these tips will help to keep our loved ones and neighbours in a positive state of mental wellbeing, after all…..self-isolation does not have to mean mental isolation.

As we are all already aware, this is a very distressing and unsteady time for many. I would like to offer some hope to those who are suffering from anxiety and anxious feelings, whether you are or have been a sufferer of anxiety in the past, or whether the unsteadiness of this current time has caused the feelings of anxiousness and unease, I hope some of the strategies below will be able to help you cope.

If you have read any of my ‘Hope’ books, you will be very aware that I am a great advocate for positive exercise and mental well-being. Many of us would leave the house on a regular basis, whether it was walking to work, or walking to drop the children at school, or a regular member of the gym, we are finding ourselves suddenly cooped up with our regular activities on hold. Making sure you are still getting regular exercise is paramount to our mental health, there are so many exercise videos on YouTube and online from beginner HIT sessions to yoga and Pilates. If you are able to leave the house, taking a brisk walk whilst getting fresh air will be invaluable. A good nights sleep and eating a balanced diet also complement exercise for their benefits on the mind.

Onto my next topic….the media….whilst it is extremely important that we are all keeping up to date with the current situation, it is also important that we take our minds off it for our own sanity. Having a ‘media free’ or ‘tech free’ time each day will help us to focus on other topics and calm our minds. I love doing puzzles and find them very therapeutic. Other activities could include, reading a book, or even cooking a nice dinner.

Spending more time at home is probably on most people’s wish lists, however, when it is suddenly thrown on us, we don’t know what to do with ourselves. The risk of not being able to socialize as we usually would could lead to a low mood slowly setting in. Getting up each day and giving yourselves a little self-care will go a long way to keep our minds positive and fresh.Wash your hair, shower regularly, put on fresh clothes, and you will feel ready to face the day.

Although the risk of anorexia nervosa is higher in females, boys and men are not immune. Interestingly, atypical eating disorders, such as ‘selective eating’ (very limited food choices) are more common in boys than girls before puberty. These are often related to developmental disorders, such as autism spectrum disorders, or to severe anxiety. However, very few of these eating problems develop into anorexia nervosa after puberty.

About 10% of people with anorexia known to health services are male. On the other hand, large community-based epidemiological studies have recently shown that as many as 30% of participants reporting a lifetime history of anorexia were male, but only a minority sought treatment. Eating disorders are associated with women and this may be an impediment to seeking treatment for men. John Prescott’s disclosure of his bulimia could be a typical example of this situation.

However, even if as many as 30% of sufferers were male, the imbalance towards the female sex is most extreme amongst psychiatric disorders. Interestingly, there is some evidence that homosexuality/bisexuality is a specific risk factor for eating disorders (particularly bulimia) in males. According to a recent study, attending a gay recreational group is significantly related to eating disorder prevalence in gay and bisexual men. The reason for the higher prevalence in non-heterosexual males is unknown at present. In some cases, the drive for weight loss may be an expression of the rejection of male sexuality, such as in men with gender identity disorders.

The motivation for initial weight loss is usually different for men than for women. Preoccupation with a muscular but ‘fat-free’ body is more common, sometimes resulting in excessive exercise and steroid abuse. This is consistent with male sexual attractiveness, but paradoxically, these strategies damage normal sexual functioning. Biologically, abnormally low weight does not allow muscle building, not just because of lack of nutrients, but also because testosterone levels fall during starvation. The low testosterone does not just affect libido and sexual performance, but also the body’s ability to build muscles. Steroids illicitly used for muscle building also interfere with normal sex hormone production, and can be harmful in the long run.

Illicit substance misuse has also been associated with anorexia in males, for a number of reasons. Firstly, amphetamines, heroin and cocaine all reduce appetite. Secondly, some underlying personality traits may present a risk for both conditions.

Research on anorexia in boys and men is limited. This is mainly because only a small proportion of clinic populations are male, so it is very difficult to recruit sufficient numbers of male participants into studies. Furthermore, the majority of research studies concerning anorexia nervosa exclude male patients from recruitment or the analysis in an attempt to keep the methodology simple. The Minnesota Semi-Starvation study, which will be discussed later, included only male participants. Hence, this study has provided invaluable information about the consequences of self-induced starvation in males.

Medical complications are more common in men than women during starvation. However, a recent study in Sweden showed that the long-term recovery rate of men hospitalised for anorexia was good. The same research group has also shown that the outcome of eating disorders in females has improved in Sweden (in contrast to many other countries). These findings may be true only for the Swedish populations, due to the effective screening programmes and early intervention in this country’s highly developed and equitable healthcare system. Finnish researchers also found better outcome for males in terms of weight restoration, but additional psychological problems were common.

When the brain is affected by dementia, logical thinking and reasoning ability are affected quite early on. However, the amygdala – the part of the brain that is the integrative centre for emotions, emotional behaviour, and motivation – is less affected. People with dementia (PwD) who have trouble processing logic and reasoning do not have a similar problem with their ability to feel emotion. Indeed, as far as research can show, people with dementia still feel happy, sad, afraid and so on, even after they can no longer speak or recognise people they know well, even when they need total support to live their lives. It seems, though, that most people – including many well-meaning carers – are unable to adjust their own behaviour and thinking to accommodate the continuance of emotional experience, along with the decrease in reasoning ability of the person they care for.

If someone has a broken leg we do not assume that they could walk on it ‘if they tried’. We do not suggest that they listen very carefully whilst we explain how to walk. We do not try to divert their attention so that they can walk without thinking. No. Instead we set the broken bone and maintain it in position with support (a leg-plaster). We allow them to rest the leg. We give them a crutch to aid movement and we accept that walking will be slow and difficult until the leg is healed. Similarly, if someone has part of their brain which is not functioning we should make allowances. We should try to keep the parts of the brain that do function in as good order as possible – by encouraging social interaction, physical exercise and general health. We should allow the brain to ‘rest’ when it needs to by not demanding actions which are no longer essential. We should supply a ‘crutch’ using memory aids, providing unobtrusive help and support. We accept that everything cannot be as it once was because this brain is not what it once was.

It is important, though, that society should recognise the relative importance of the emotions which come to predominate when logical thought and thought processing are deteriorating. Society in general does not much like domination by the emotions. ‘Civilised’ people should learn to control emotion and apply logic and reason to manage their everyday life, it is thought. But what if we can no longer use our logic and reasoning to help us come to terms with emotions? Suppose we are unable to understand and work out why we feel sad or happy? Imagine if we feel these emotions overwhelmingly, but we are unable to deal with them by a change of scene, by talking through our feelings, by taking actions to alleviate the misery or express the happiness. Imagine being no longer able to speak coherently enough to tell anyone how frightened you feel or how angry. What might you do? How might you try to express yourself? Perhaps you would try to hide somewhere, or to run away and escape. Or you might shout and get angry. Perhaps if no one made any effort to understand, you might try to use physical methods to show them how you feel.

How the brain works, a very logical and straightforward article produced by Alzheimer’s Australia, gives a clear and basic introduction to the brain dysfunction involved in dementia and always helps me to picture what is going on inside of the head of someone affected by this disease. The article explains that the brain can be thought of as a factory and that the factory runs at peak efficiency when all the parts are working.

At the front of this factory (the frontal lobes) are the directors. They make plans for the factory and decide on who is going to do what and when. As things get underway they get feedback or other information as to how well things are going and they make judgements on what looks good and what does not look so good. Then they make further decisions, to change that or to keep this, and show their appreciation and annoyance. Planning, organising, judging, decision-making and appreciation therefore take place at the front of the brain.

In the middle of the factory (the parietal association cortex) are the managers. Each manager runs his/her own department. The left side is the talking side: there is a speech department that moves the throat, tongue and lip muscles, a language department that is responsible for finding the words you want and knowing the words’ meaning, a music department, and various other departments. The right side is the picture side, with a motor department that helps you find your way around a building, knows where you are when you are driving a car, puts your arm through the sleeve of your coat, and so on.

The directors pass their plans on to the managers, and the managers make sure the directors’ plans are carried out. In order to do this, directors and managers communicate freely with one another, sending messages back and forth.

At the bottom of the factory (the limbic region, amygdala and basal ganglia) are the workers. They do not know what the directors’ plans are, but they know their job and they do that same job day in, day out. They take care of things like appetite control, the need for water, staying alert and awake or going to sleep, as well as basic emotions, such as turning on tears, making the face red and increasing the pulse rate.

When brain damage occurs, basically someone gets sacked. It can be the director, a manager or a worker, depending on where the damage takes place. Someone can also go on temporary leave of absence – for example, when there is a temporary swelling or loss of blood supply in the brain that is reversed in a short time.

The result of any injury, whether permanent or temporary, is that the efficiency of the factory is reduced. Messages are sent but are not picked up. Directors get annoyed. The managers get tired and the emotional workers get overwrought. Confusion reigns.

Understanding who has been fired and who is still on the job can help in interpreting the behaviour of people living with dementia.

Mental health and coping with anxiety affects everyone, and if you are suffering from an invisible illness it can be even more difficult. It’s #mentalhealthweek so here are some tools for looking after your emotional and mental health when dealing with chronic illness, whether it be IBD, IBS, CFS, ME or other fatigue/auto-immune conditions.

How can we deal with anxiety and invisible illness?

Since many patients feel stress can trigger their symptoms, it is vital to try to get a handle on anxiety. It has been suggested that support for this should be part of Inflammatory Bowel Disease (IBD) patients’ care plans, yet currently only 12 per cent of IBD clinics offer this. Therefore, it is clearly an area where more medical services need to be directed. As I discussed in Chapter 1, initial consultations after being diagnosed can lead to the patient being overwhelmed with information and having a variety of leaflets thrust into their hands about the disease they can only take in later. But where’s the leaflet that tells us how to cope with the associated emotions? The leaflet that gives us ways of not breaking down, and staying strong? The leaflet that offers support groups and websites?

Hopefully the studies I have cited have highlighted the growing link between mental health and IBD. Of course, if you feel you are struggling with anxiety and depression it is vital you speak to your GP urgently. If you have done this and are looking for some self-help suggestions to deal with times of worry and help manage your anxiety, then the guidance below from Sally Baker – a therapist who works specifically with the mind-body connection – may be beneficial. (It is important to be aware at the same time that these tips offer general guidance which cannot replace the individual advice of a medical professional and if you are feeling any new symptoms of anxiety and depression, then it is very important to see your GP.)

Advice from Sally

When Sally works with clients living with chronic ill-health she recognises how having little or no confidence in how one will physically feel from day to day encourages self-doubt and frustration. As you are probably aware, feeling negative about yourself can create a vicious circle of frustration, disappointment and anger. One of the first therapeutic approaches she suggests to break this cycle of negative self-thinking is to encourage patients to gain an enhanced level of self-awareness to highlight the impact those uncomfortable emotions have on them.

She has found one of the most beneficial ways of discovering if a person is prone to negative thoughts about themselves is to explore the kind of things their inner voice says to them. If on reading this your response is, ‘What inner voice? – I don’t have one!’ then that is your inner voice.

Your inner voice runs an almost continuous internal dialogue commenting on everything you do and often makes judgements on how well you do it too. Happening as it does just below conscious awareness, one’s inner voice goes unchecked, and unchallenged, for most of the time.

For many people, especially those living with chronic illness, their inner voice is rarely a source of uplifting encouragement. It is more likely to give an unremitting flow of self-criticism, and negative self-judgements (everything from ‘I hate my body’ to ‘What am I doing wrong?’). Taking the time to become aware of how your inner voice speaks to you can accurately demonstrate to you your own level of self-judgement and self-condemnation. Tuning in, and clearly hearing your inner voice, is the crucial first step to silencing the draining and dispiriting stream of negativity that can hinder moving forward and making positive changes. Sally suggests spending a little quiet time – just a few moments – every day for about a week tuning in to your inner voice, and simply listening and noting down the negative statements. A therapy tool she then uses to resolve those negative, limiting beliefs is called Emotional Freedom Technique (EFT or ‘Tapping’). EFT is an energy therapy that has proved highly effective for revealing true feelings, in this case prompted by one’s negative self-talk.

Once you have a greater awareness of your own negative self-talk you can then apply another of her core therapy tools – called Percussive Suggestion Technique (PSTEC) – to turn-down, or dispel, the emotions attached to the negative beliefs you have about yourself. Turning off negative self-talk is the beginning of a powerful journey which can transform a former inner-critic into your greatest advocate – someone cheering for you instead of undermining you.

Nutrition-related health issues seem to take an age to become part of accepted medical practice. The medical establishment requires comprehensive scientific evaluation, randomised trials and peer review before a new drug can be licensed, for instance. The pharmaceutical company has to weigh up the costs of research and development versus the potential profit to be made from launching a successful product that can earn a good return on their investment. (When you add in the factor that 80 per cent of their budget goes on marketing, it is clear the stakes are high indeed.) As real food is simply real food and can’t be licensed, branded or patented, there is little impetus for the medical community to fund costly research.

Medical research over the last couple of decades has, nevertheless, highlighted how an unhealthy gut can contribute to many physical diseases and these findings are becoming more accepted in mainstream medicine. Clinicians increasingly agree that the gut-brain axis also plays a crucial part in emotional wellbeing, including the development of conditions as diverse as chronic fatigue syndrome, depression and autism.

The Gut-Brain Axis

The gut-brain axis is a way of describing the interrelationship between gut health and brain health. The various aspects of digestion are controlled via the vagus nerves by a complex set of neurons embedded in the oesophagus, stomach, intestines, colon and rectum. The brain sends messages to all the nerves in your body, including the neurons that control digestion. All work efficiently enough until a person is anxious or stressed on an ongoing basis. You perhaps know for yourself that if you are feeling nervous your stomach can feel upset and queasy. The reason for this is that strong negative emotions, stress and anxiety increase cortisol and adrenaline, which then stimulate the sympathetic nervous system and shut down the parasympathetic system, which includes control of the gut. This causes a physical chain reaction:

* Reduction in pancreatic enzyme production

* Reduction in gall bladder function

* Reduction in the production of stomach acid

* Slowing down of peristalsis – the involuntary muscle movements essential for moving food efficiently through intestines for the absorption of nutrients

* Reduction in blood flow to the intestines

* Suppression of the intestinal immune system

In the short term, this allows the body to focus its resources on ‘fight or flight’ – a good survival mechanism. However, with ongoing stress and anxiety, this cumulative slowing down and suppression of the digestive process can, over a prolonged period, lead to a condition called ‘small intestinal bacterial overgrowth’ (SIBO). As the digestive process is compromised by stress and anxiety, the lack of stomach acid allows the stomach and small intestine – which should both be pretty much microbe free – to be colonised by unhealthy bacteria, and yeasts, causing foods to be fermented rather than digested. In addition to gas and bloating, compromised digestion leads to declining absorption of nutrients, which contributes to the loss of the co-factors needed for good digestion, and consequently further gut problems.

Now consider this situation lasting for extended periods of time. The integrity of the gut lining may be compromised, contributing to gut permeability (‘leaky gut’) that may be sufficient to produce chronic low-grade inflammation.

Chronic Inflammation

The inflammatory process includes the production of cytokines, chemical signals of inflammation that are carried by the blood to the brain. The cytokines can activate cells – so that the inflammation originating in the gut thereby causes widespread inflammation in the rest of the body, including the brain.

The impact of brain inflammation is that the brain has reduced nerve conductance which – guess what – shows up as depression, anxiety and stress.

This vicious circle can self-perpetuate and requires long-term changes to heal the gut, which in turn will help to heal the brain. This is done through changes in behaviour and improving levels of nutrition through changes to food choices. To improve your natural resilience to stress it is important to increase the amount of healthy polyunsaturated omega-3 oils in your diet, so look for oily fish, grass-fed meats and butter made from the milk of grass-fed dairy herds. Good plant sources include hemp seeds, linseeds, chia and some nuts and nut oils (macadamia, almond).

If you consider yourself to be depressed it will be helpful for your recovery to manage your stress levels, improve your sleep patterns and add nutritious and gut-healing foods into your regular eating plan.

Do bear in mind, however, that you may also need professional help if you have been suffering from this debilitating psychological disorder for some time. Please make sure you are accessing all the medical and psychological support you need. Try hard not to add isolation to an already challenging situation.

For many who are compulsively driven to eat for emotional reasons, not hunger, food has become a manifestation of self-loathing and a complex method of self-harming, or even a way of failing to thrive. These people crave food, avoid food, binge on food and obsess about food. Thinking about food fills their every waking moment. Food has become a way to celebrate and commiserate with themselves. In fact, it is their everything – except a natural way to sate hunger or be a source of healthy nourishment.

Typically, emotional eaters feel their appetite for food is out of their control and is counter to their heart’s desire to be slimmer than they are. They feel their inability to resist their food cravings proves how worthless they are as they trade their dreams of being slimmer for swallowing down foods they consider to be ‘bad’ or ‘forbidden’. They also often believe that the excess weight they carry is their own personal failing and visible proof for all to see that they are weak, inadequate or just plain greedy. The story they tell themselves continues with the common beliefs that if they were stronger, or had more will-power, or were simply just ‘better people’, then they would find it easy to manage their weight-versus-food-intake without the daily time-consuming over-thinking that they endure.

Every emotional eater has his or her own unique set of circumstances and history, but there are often similarities in thinking and in the belief system that defines each emotional eater. For instance, emotional eaters judge themselves harshly and their self-talk – the quiet voice that everyone hears within their own mind – is particularly critical and unforgiving. We also understand that emotional eaters can be triggered to binge eat when experiencing negative or challenging emotions, such as loneliness, sadness or anger.

Disordered thinking around food that emotional eaters may experience makes it particularly challenging to establish a nutritionally balanced way of eating that can be sustained for the long term. This is particularly true for those who are attempting to stabilise their weight after years, or possibly even decades, of yo-yo dieting.

Emotional eaters do not generally fare well following a type of diet that brings any of the following circumstances into play:

4. Diets that replace meals with fake-foods, such as shakes, snack bars, instant soups or variations on this theme, often fail for emotional eaters when they are challenged with the inevitable reintroduction of real food.

5. Diets that promote or exclude whole groups of food, impose excessive or irrational rules or demand a specific cooking methodology can all help encourage unhelpful over-thinking about food that emotional eaters are already prone to. This includes the eating of only ‘free-from’ foods, including gluten-free (without a confirmed medical need), or following a strict macrobiotic diet, or eating only raw foods.

There is no single definition of typical emotional eating. It’s a common misconception that all emotional eaters are overweight. Many are within normal weight range but only because of their obsessive dieting, bingeing and disordered eating that will be a well-kept secret they share with no one. The same negative judgements emotional eaters make about themselves are common to the overweight and the obese, and the dangerously underweight for that matter. All share the trait of unrelenting over-thinking about food coupled with harsh, critical self-judgements.

To give you a sense of a typical emotional eater you need to understand that their innate sense of self-worth – how they actually see themselves as a worthy person – is closely linked to the numbers on their bathroom scales. A pound lost, or a pound gained, can set the tenor of their entire day. Also, foods are never neutral. They are forensically studied and determined to be good or bad.

Emotional eaters battle with their own body’s hunger and cravings. They know there have been times when they have succumbed and eaten one ‘bad’ food only for it to start a tsunami of overeating, or even bingeing and purging, with all the accompanying feelings of shame and self-loathing. An emotional eater’s attitude towards him/herself and food is not logical. The extent of his/her preoccupation with food and body weight is often a private source of great personal distress and shame. The reasons for this all-consuming link between food, body weight, self-definition, and how the individual feels about being him/herself in the world, are varied and inevitably complex.

Let’s be clear, and define emotional eating as a behaviour that occurs only in the developed world, the lands of perceived plenty. Negative selfjudgements; obsessive over-thinking about calories; skipping meals; bingeing and purging; or any of the other many aspects of emotional eating do not exist in countries of food scarcity or where people struggle for survival. It’s noteworthy that as third world countries emerge economically onto the world stage they open their doors to western influences and their seductive power. The socially mobile classes of any indigenous population quickly develop a taste for western fashion, and music, as well as western foods. The Standard American Diet of refined carbohydrates, calorie-dense fast-foods and fizzy drinks is now exported all over the world. Adopting it is a way of aping western consumption, and values, and can be found in the cities of China, Russia and India, as well, increasingly, as in more remote outposts. It also causes sectors of the population of these countries to judge themselves negatively against the narrow, westernised standard of perfection. With that comes self-dissatisfaction – a step on the road to emotional eating that was not apparent just a few decades ago.

Are you an emotional eater?

Here are some questions to ask yourself if you think you might be an emotional eater: